The Association of Modified Yale Perioperative Anxiety Scale and Pediatric Anesthesia Behavior on Postoperative Emergence Delirium in Children: A Prospective Cohort Study

Background: Children who experience emergence delirium (ED) are at risk of adverse events after anesthesia. Assessing the child's behavior before anesthesia using clinical tools can be useful to prevent the occurrence of ED. This study aimed to identify and quantify the association between pediatric anesthesia behavior (PAB) and the modified Yale perioperative anxiety scale (mYPAS) on postoperative ED in pediatric patients undergoing general anesthesia. Materials and Methods: A prospective cohort study was conducted on 100 pediatric patients aged 2-12 years who underwent elective surgery with general anesthesia with the American Society of Anesthesiologists physical status I and II. The preoperative anxiety was measured by PAB score and mYPAS score, and their prediction ability of both scores for ED was compared. ED was defined as a pediatric anesthesia delirium emergence (PAED) score of more than 12. Results: ED occurred in 33 patients (33). The mYPAS has a good discrimination ability with area under the curve 0.76 (95 confidence interval 0.65-0.86). The mYPAS score of 29 correlated with the highest sensitivity (78.8) and specificity (73.1) and the mYPAS score of ≥29 has an odds ratio of 11.7 for the occurrence of ED. PAB correlation could not be assessed. Conclusion: Preoperative anxiety is associated with ED. The mYPAS has a better correlation with postoperative ED than the PAB score.